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html contact form php mailer

vickytanghm

By vickytanghm
in PHP Coding Help

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vickytanghm Newbie

vickytanghm

Posted
Posted
Hi Guys,

 

i need help on this, html contact form php mailer.

 

<form name="contact_form" method="post" action="mailer1.php" onSubmit="return evalid()">

        <fieldset>

        <table>

          <tr>

          <td><b>Personal Information</b></td>

          <tr>

            <td>Title</td>

            <td colspan="2"><select name="title[]">

              <option selected="selected">Mr</option> 

              <option>Mrs

              <option>Ms

              <option>Mdm

              </select>

            </td>

          </tr><tr>

            <td>Name </td>

            <td colspan="2"><input name="name" type="text" /></td>

          </tr><tr>

     <td>NRIC </td>

            <td colspan="2"><input name="nric" type="text" /></td>

          </tr><tr>

     <td>Date Of Birth </td>

            <td colspan="2"><input name="dob" type="text" /></td>

          </tr><tr>

     <td>Nationality </td>

            <td colspan="2"><input name="nationality" type="text" /></td>

          </tr><tr>

     <td>Race </td>

            <td colspan="2"><input name="race" type="text" /></td>

          </tr><tr>

     <td>Occupation </td>

            <td colspan="2"><input name="occupation" type="text" /></td>

          </tr><tr>

            <td>Your E-mail </td>

            <td colspan="2"><input type="text" name="email" /></td>

          </tr><tr>

     <td>Mobile </td>

            <td colspan="2"><input type="text" name="mobile" /></td>

          </tr><tr>

     <td>Home </td>

            <td colspan="2"><input type="text" name="home" /></td>

          </tr><tr>

     <td>Highest Qualification Attained </td>

            <td colspan="2"><input type="text" name="hqa" /></td>

          </tr><tr>

     <td>Number Of Years Of Tutoring </td>

            <td colspan="2"><input type="text" name="noyot" /></td>

          </tr><tr>

     <td>Secondary </td>

            <td colspan="2"><input type="text" name="sec" /></td>

          </tr><tr>

     <td>JC/POLY </td>

            <td colspan="2"><input type="text" name="jcpoly" /></td>

          </tr><tr>

     <td>University </td>

            <td colspan="2"><input type="text" name="uni" /></td>

          </tr><tr>

            <td>Results or Grades attained for all school attended </td>

            <td colspan="2"><textarea name="rmessage" style="width: 250px; height: 100px"></textarea></td>

          </tr><tr>

     <td>Self Introduction </td>

            <td colspan="2"><textarea name="smessage" style="width: 250px; height: 100px"></textarea></td>

          </tr><tr>

     <td>Minimal Expected Rate </td>

            <td colspan="2"><input type="text" name="mer" /></td>

          </tr><tr>

     <td>Teach IP Student</td>

            <td colspan="2"><select name="title">

              <option selected="selected">Yes</option>

              <option>No

          </tr><tr>

     <td>Tutoring Location In </td>

          <td style="vertical-align">  

    <input type="checkbox" name="location[0]" value="East"> Central<br>

    <input type="checkbox" name="location[1]" value="East"> East<br>

    <input type="checkbox" name="location[2]" value="North"> North<br>

<input type="checkbox" name="Others,Please Specify" value="Others,Please Specify"> Others,Please Specify<br>

            <textarea id="text_7" name="Others,Please Specify" rows="2" cols="24"></textarea>

    <td style="vertical-align"> 

    <input type="checkbox" name="location[3]" value="NorthEast"> NorthEast<br>

    <input type="checkbox" name="location[4]" value="NorthWest"> NorthWest<br>

    <input type="checkbox" name="location[5]" value="West"> West<br>  

          </tr><tr>

     <td>Pre-school </td>

     <td>

          <input type="checkbox" name="Preschool" value="Preschool"> <br>

     </tr><tr>

     <td>Primary School </td>

          <td style="vertical-align">  

    <input type="checkbox" name="English" value="English"> English<br>

    <input type="checkbox" name="Mathematics" value="Mathematics"> Mathematics<br>

    <input type="checkbox" name="Science" value="Science"> Science<br>

    <td style="vertical-align right"> 

    <input type="checkbox" name="Chinese" value="Chinese"> Chinese<br>

    <input type="checkbox" name="Malay" value="Malay"> Malay<br>

    <input type="checkbox" name="Tamil" value="Tamil"> Tamil<br>

          </tr><tr>

     <td>'O' Level </td>

          <td style="vertical-align">  

    <input type="checkbox" name="Amath" value="Amath"> Amath<br>

    <input type="checkbox" name="Biology" value="Biology"> Biology<br>

    <input type="checkbox" name="Bio/Chem" value="Bio/Chem"> Bio/Chem<br>

    <input type="checkbox" name="Bio/Physics" value="Bio/Physics"> Bio/Physics<br>

    <input type="checkbox" name="Biz Studies" value="Biz Studies"> Biz Studies<br>

    <input type="checkbox" name="Chemistry" value="Chemistry"> Chemistry<br>

    <input type="checkbox" name="Chinese" value="Chinese"> Chinese<br>

    <input type="checkbox" name="Emath" value="Emath"> Emath<br>

    <input type="checkbox" name="English" value="English"> English<br>

    <input type="checkbox" name="Geography" value="Geography"> Geography<br>

    <input type="checkbox" name="Higher Chinese" value="Higher Chinese"> Higher Chinese<br>

    <input type="checkbox" name="History" value="History"> History<br>

    <input type="checkbox" name="Others,Please Specify" value="Others,Please Specify"> Others,Please Specify<br>

    <textarea id="text_7" name="Others,Please Specify" rows="2" cols="24"></textarea>

    <td style="vertical-align middle"> 

    <input type="checkbox" name="Literature" value="Literature"> Literature<br>

    <input type="checkbox" name="Malay" value="Mala"> Mala<br>

    <input type="checkbox" name="Phy/Chem" value="Phy/Chem"> Phy/Chem<br>

    <input type="checkbox" name="Physics" value="Physics"> Physics<br>

    <input type="checkbox" name="POA" value="POA"> POA<br>

    <input type="checkbox" name="Science" value="Science"> Science<br>

    <input type="checkbox" name="Tamil" value="Tamil"> Tamil<br>

    <input type="checkbox" name="Hindi" value="Hindi"> Hindi<br>

    <input type="checkbox" name="Economics" value="Economics"> Economics<br>

    <input type="checkbox" name="Business English" value="Business English"> Business English<br>

    <input type="checkbox" name="Business Chinese" value="Business Chinese"> Business Chinese<br>

          </tr><tr>

     <td>'A' Level </td>

          <td style="vertical-align">  

    <input type="checkbox" name="Accounting" value="Accounting"> Accounting<br>

    <input type="checkbox" name="AO Chinese" value="AO Chinese"> AO Chinese<br>

    <input type="checkbox" name="Biology" value="Biology"> Biology<br>

    <input type="checkbox" name="Chemistry" value="Chemistry"> Chemistry<br>

    <input type="checkbox" name="Computing" value="Computing"> Computing<br>

    <input type="checkbox" name="Economics" value="Economics"> Economics<br>

    <input type="checkbox" name="General Paper" value="General Paper"> General Paper<br>

    <input type="checkbox" name="Others,Please Specify" value="Others,Please Specify"> Others,Please Specify<br>

    <textarea id="text_7" name="Others,Please Specify" rows="2" cols="24"></textarea>

    <td style="vertical-align"> 

    <input type="checkbox" name="Higher Chinese" value="Higher Chinese"> Higher Chinese<br>

    <input type="checkbox" name="History" value="History"> History<br>

    <input type="checkbox" name="Literature" value="Literature"> Literature<br>

    <input type="checkbox" name="Mathematics" value="Mathematics"> Mathematics<br>

    <input type="checkbox" name="Physics" value="Physics"> Physics<br>

    <input type="checkbox" name="Project Work" value="Project Work"> Project Work<br>

    <input type="checkbox" name="Mgmt of Biz" value="Mgmt of Biz"> Mgmt of Biz<br>

    <input type="checkbox" name="Georgraphy" value="Georgraphy"> Georgraphy<br>

    </tr><tr>

    <td>Diploma </td>

          <td style="vertical-align">  

    <input type="checkbox" name="Accounting" value="Accounting"> Accounting<br>

    <input type="checkbox" name="Business" value="Business"> Business<br>

    <input type="checkbox" name="Computing" value="Computing"> Computing<br>

    <input type="checkbox" name="Engineering Maths" value="Engineering Maths"> Engineering Maths<br>

    <input type="checkbox" name="Others, Please Specify" value="Others, Please Specify"> Others, Please Specify<br>

    <textarea id="text_7" name="Others,Please Specify" rows="2" cols="24"></textarea>

    <td style="vertical-align"> 

    <input type="checkbox" name="Management" value="Management"> Management<br>

    <input type="checkbox" name="Fine Arts" value="Fine Arts"> Fine Arts<br>

    <input type="checkbox" name="HR" value="HR"> HR<br>

    </tr><tr>

    <td>Foreign Language </td>

          <td style="vertical-align">  

    <input type="checkbox" name="Bahasa" value="Bahasa"> Bahasa<br>

    <input type="checkbox" name="French" value="French"> French<br>

    <input type="checkbox" name="German" value="German"> German<br>

    <input type="checkbox" name="Japanese" value="Japanese"> Japanese<br>

    <input type="checkbox" name="Korean" value="Korean"> Korean<br>

    <input type="checkbox" name="Spanish" value="Spanish"> Spanish<br>

    <input type="checkbox" name="Others, Please Specify" value="Others, Please Specify"> Others, Please Specify<br>

    <textarea id="text_7" name="Others,Please Specify" rows="2" cols="24"></textarea>

    <td style="vertical-align"> 

    <input type="checkbox" name="Thai" value="Thai"> Thai<br>

    <input type="checkbox" name="Vietnamese" value="Vietnamese"> Vietnamese<br>

    <input type="checkbox" name="English" value="English"> English<br>

    <input type="checkbox" name="Mandarin" value="Mandarin"> Mandarin<br>

    <input type="checkbox" name="Malay" value="Malay"> Malay<br>

    </tr><tr>

    <td>Piano </td>

     <td>

          <input type="checkbox" name="Preschool" value="Preschool"> <br>

     </tr><tr>

     <tr>

     <td style="vertical-align"> 

     <td><input type="submit" name="Submit" value="Submit">

           <input type="reset" name="reset" value="Reset"></td>

            

          </tr>

        </table>

        </form>

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cyberRobot Prolific Member

cyberRobot

Posted
Posted

As Muddy_Funster said, it would be helpful to know what you need help with.

 

One thing I noticed, however, is that several of your form fields are using the same name. For example:

<input type="checkbox" name="Others,Please Specify" value="Others,Please Specify"> Others,Please Specify<br>
<textarea id="text_7" name="Others,Please Specify" rows="2" cols="24"></textarea>
 
The field names need to be unique. Otherwise, only the last field value is sent through the form submission.
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